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AF - 43960� SUBJECT P . City of Fridley ,� AT THE TOP OF THE TWINS g U I L D I N G P E R M I �� r ; � N� � � COMMUfJITY DEVELOPMENT DIV. �y r � y � PROTECTIVE INSPECTION SEC. l XQ � ' CJ i � � � - /��'1 � CITV HALL f RIDLE� 55432 NUMBEA AEV DATE PAGE OF APPROVED BY �"""�'� �'' 612-571-3450 910-F15 4/19/96 / / 108 ADDRESS 6554 Brookview Drive NE t IEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. (} 2 Brookview 2nd Addition SHEET 2 PROPERTV OWNER MAII ADORESS IIP PHONE Mike/Becky Hobbs 6554 Brookview Dr NE 571-0079 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Midwest Restoration 1628 Hw 10 M ls. MN 784-2772 5267 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE UCENSE NO. 6 USE OF BUILDING Restoration 7 CLASS OF WOHK Cl NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof House & Gara e(18 S) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS AFE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIF CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WOFiK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPL�CATION 1 STALIS GARAGES AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAIUATION SURTAX AND ORDINANCES GOVERNING THIS TVPE Of WORK WILL BE COMPLIED � 1, 440 �• 72 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES N07 PRESUME TO GIVE AUTHOfiITY TO VIOLATE OR CANCEI THE pEqM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STAT OR LOCAL LAW REGULATING CON- �[�,8. SO Fire SC .p 1.�F�F STRUCTION OR THE PERFORMANC OF CONSTRUCTION PLAN CHECK FEE TO7AL FEE b License SC $5.00 $55.66 5iG ATUf7E C " AUTHOR12EDAGENT IDATEi WHEN PfiOPER , VALIOATED THIS IS VOUR PERMIT � r f ��--� S�iGNATURE OF OWNEF7 iif OWNEA BU�LDERI IDATEI B G�NSP �1iiE N�W ADD1V • ALTER [l [l [1 - CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective 3/1/96 ConstructionAddress: �� '� �jQ��,.�r//�� , Legal Description: Owner Name & Address: s� Tel. #�%/- D o 7� Contractor: �1,��T �S� ��,� MN LICENSE # �2� 7 � y� �� Address: ��_�G��v /o � s /�� Tel. # ��%%TZ LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlViPROVEMENT Length Width Height Length Width Height Len Width Hgt/Ground ; �-�i�c?� � �� S � ) �� ,� Sq. Ft. Sq. Ft. Sq. Ft. �� Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks Type of Construction: �Fstimated Cost: $ ��-�`"--�----� Approx. Completion Date: �� (Cost on Back) Driveway Cur Cut Width Needed: Ft. + 6,F� _,, Ft x$ _$ DATE: �' APPLIC�} Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Tel. #,'�f� Z�l� $ �- °: . S Z� Fee Schedule on Reverse Side $ % - `� .001 of Permit Valuation (1/lOth%) $ % � $.50/$1,000 Valuation $ $900 per SAC Unit .: . $ � • ��(> $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt_ "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] ,; $ �-� �� sue�ecr PERIyI . City of Fridley ` � AT THE TOP OF THE TWINS B U I L D I N G P E R M I T C �� r — ; � RECEIPT NO. � COMMUNITY DEVEIOPMENT DIV. � � L_�� , r � � PqOTECTIVE INSPECTION SEC. 21j %� i � �.✓ ' � �'��l � CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE UF APVROVED Bv �----�•� ,•' 612-571-3450 9t0-F�5 7/14/97 / / 108 ADDRESS 6554 Brookview Drive NE 1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oESC�. 4 2 Brookview 2nd Addition SHEET 2 PROPERTY OWNER MAIL AODRESS ZIP PHONE Michael/Rebecca Hobbs 6554 Brookview Drive NE 571-0079 3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO Same 4 ARCHITECT OR DESIGNER MAIL AD�RESS ZIP PHONE IICENSE NO. 5 ENGINEER MAII. ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION O ALTERATION � REPAIR O MOVE O REMOVE 8 DESCRIBE WOFK Reside House & Garage 9 CHANGE OF USE FROM TO STIPULATIONS Install building wrap and have inspection of same unless manufacturer's specifications state it is not required. TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING Of7 AIF CONDITIONING THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOF A PERI00 OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UN17S OFFSTREET PARKING 1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALIS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF IAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIE� FiEREIN OR NOT. THE GRANTING OF A DERMIT �3aSOO �1.%S DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEqM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $87 � 2)r Fire SC �3. SO STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECKfEE TOTALFEE $92.50 GNATUREOFCON'R ,TOROR UTH0�71ZEDAGENT �DATEI WHEN PAOPER�Y V DATED THIS IS YOUR PERMIT � . �� - , y _ SiGNATUAE OF OWNEA UF OWNEA BUIL EAi �DATEi BlD �NS� f�FTE p _ .� NEW ADDN ALTER r� [7 Ll ConstructionAddress: CITY OF FRIDLEY , SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION � ��fbO�Yl�� li_ �� Effective 1/1/97 �/ r � Legal Description: j� }- �.} '�� K -�- -�y �� v� � �� Owner Name & Address: �Y�,P �,u�� I �t-�gbecea �ob�,� �5�y �rc'oKv7� �v rJFTeI. # 5� i- d079 Contractor: (g ��v S�e �v e 5 MN LICENSE # Address: � Attach to tius application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING AREA: Length Width Height _; Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: v c- S�iC�l-e_- �n j t S�e C►* C14-Y C��e Construction Type: y ��u � 51� �y� Estimated Cost: $� i_S�C� .°L� (F_ee Schedule on Back) Dnveway C�ub Cut Width Needed: Ft. + 6 Ft = Ft �x $ _$ DATE: '? � �'� - q `l APPLICAN'I': �.c�. � � Tel. # 3 �] I - p D'7 % Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPUL/�TIONS: CITY USE ONLY , ! $ <�` `�' �� Fee Schedule on Reverse Side $ � � -� �' .001 of Permit Valuation (1/lOth%) $ � `%� $.50/$1,000 Valuation $ $950 per SAC Unit � $5.00 (State Licensed Residential Contractors) � Alt. "A" or Alt. "B" Above � $450.00 Conservation Plan Review � Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] �_ �'� _ S� CITY OF FRIDIEY INSPECTION DIV, 6a3i UniversityAve NE F�idiey, MN 55432 572-3604 i � � . i APPLICATION FOR POW�R PLANTS AND HEATING, COOLING, VENTILA710N, REFRIGERA710N AND AIR CONDITIONING SYSTEMS ANp pEVICES Residentiat Fumace Shell and Duct Work, Burner - Aiso Rep{acement Furnace ��^�- " — 7 � U�� L�� Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning - At! Sizes All Othe�s/Repairs & AReratlons (LiST ON BACt� 1% of Value of Appfiance or Work Commercia!/I ndustrial 1% of Valus oi Appiiance or Work Rate 70TAL 3G � a� $ �e:eo �3 ov $ 10,00 $ $ 10.00 $ $ 10.00 $ $�A�D $s� � U�i State Surcharge 70TAL FEE , 50 �$ S 57J MINIMUM FEE FOR ANY HEATING/COOLING1VENTILATION REFRtQERATION/AIR CONDITtONING PERMIT IS �15.Op PLUS THE 5,50 37ATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditione�s can not be placed in a side yard without written permission trom adJoining property owner. Effective On January 1, 1993 ��-°�`� q/��19 � JOB ADDRESS �53� � � �f The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Building Division, and hereby declares that all the facts and representations sfated in this application are true and correct, +,�—�,1893 OWNER ►�-�� S �I � 007 �l BUILpING USED AS v l ESTIMATED COST IJr�J DO �`� PERMIT NO. /:�c� � � � • ; � •- ; No, of Heating Units � Circle One (Steam} (Hot Water) arm ' Trade Name U�,c� Size Na. UG,�h�d L BTU � 7 SUC� HP EDR Fuei `��C G� , Total Connected Load 11' �'—` Burner 7rade Name Size No. � BTU MP EDR HEATING COMPANY ��r�.c_n_,c� ��-u- Signed E3y '7 �Gc� Tel No. S�3 7-c� �/ Approved By Rough-In Date Final Date FILL OUT BACK SI FOR STACK VERIFiCATION ON REPLACEMENT FURNACE CHIMN$Y AND STACR VSRIFICATION The undersigned hereby verifies that the existing chimney or stack: l. Has been carefully examined Yes (�j No () 2. Is free from rust or deterioration � Yes (� No () 3. Has no foreign objects lodged within Yes (�' No () 4. Is securely supported Yes (� No O 5. Meets all current Code requirements for size and total BTU's connected Yes ("� No () 6. Has total heating BTU's of � 7� O v _ All other BTU's �Q�/Ud ' � TOTAL BTU' s / U 7 � S U U Remarks List Alterations Being Done: �� HEATING COMPANY Sl1PERI0R CONTRACTORS INC Signed By Crystal, Mn 55422 � Date — � `- l� - �� +rr-. v• � ��vCC 1 IIYJI 6431 University Ave NE Fridley, MN 55432 572-3604 Basement Floor 1 Floor 2 Fioor 3 Fioor 4 PLUMBING FIXTURE RATES: APPLICATION FOR PLUMBING AND GAS FITI'[NG PERMIT MARK�NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR ...; ;;:;.::;:;.::; Wash �•nYi�.!F,.?:•:-`±ii C:::;r t'•r. .... �<'`'`.' ; .f..:... �t#�k�::>:::;:,»:;: FI00� �.'�`.'�':.�tf�>:>�'�=: ;.:fi:.::;::::::_�: . Auto. t�..j,.�v•F-':`": :: ({:i�i.;�:i�:i;{::iii. ..:� v::.:i.; tk�'��`''<>� Shower :�:i��i�t<'::=�:�<` Drai <::;x::<:::;.,.:::: ....., . .:.;-:. . :��-». .. :: .tl�.;:<::�::�> ra :� ::::..::,., _ . � ............::::.,. ft B��f�:_:;::::;: Washer Effective On May 10, 1999 Gas NO. RATE TOTAL JOB ADDRESS_ ��}f'�.� � 5 �(�J/(,.�� j�j,pyJ New Fixtures Old Opening, New Fixture Beer Dispense� Blow Off Basin � Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** �_ Gas Range•' Gas Dryer"" Back Flow Preventer Required ()Yes () No Type $ �.oa $ 4.OQ $ 5.00 $ 7.00 $ 7.00 $ %.�0 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ' ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE 0 $,20. 50 Heater Elec The undersigned hereby makes application for a permit fo� the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this aaQlication are true and correct. HOBBS, MIKE/BECKY 6554 BROOKVIEW DRIVE hl.E. FRIDLEY, MN 55A32 Owner (�63) 571-0�79 Building Used As. � Estimated Cost� �od� � �t / ) c PERMIT NO. �! �-,}C �:_�� PLUMBING COMPANY Q ��L—f�%� p�I(�%j/J�J� SIGNED BY ` !�� TEL N0. �� u 7- �/033 ,� Approved By Rough-In Date Final Date �`y %'�� 'ii�► i i u � ; : ► ii= ► ►ii1 t i� ■ ' : ._: "'COMBUSTION AIR SHALI BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. Building BUILDING Permit No.: U`w�l'v � Inspections RESIDENTIAL APPLICATION Received By: ; 763-572-3604 CITY OF FRIDLEY Dat��d$ E P 0 2(�09 763-502-4977 FAX EFFECTIVE 8-19-09 DATE �7 ' I'Cj�% YOUR E-MAILADDRESS SITE ADDRESS �S S�i Br��,� u��r �ie .tV � r��`d f�,. THIS APPLICANT IS: ❑ OWNER �,CONTRACTOR PROPERTY OWNER/ NAME: TENANT ADDRESS: CITY STATE z[p PHONE: CONTRACTOR NAME:_(��,�P,;,�f B�iI,I��: i�-�;ck�•i� L� C SUBMIT A COPY OF S1'ATE LICENSE # o�� ,�$eq�/S EXP DATE � YOUR STATE LICENSE � �� 'fi�� AND CERTIFICATE OF ADDRESS: j�%j I?6u'�� S,�- C[TY Ssuf1� �vc, STATE M,R�LIP S�� INSURANCE PHONE • oZ�Q CI d�i FAX � .2a '` PROPERTY TYPE I�"SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED �WINDOWS ❑ BASEMENT FINISH O ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING � QTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR �REMOD LING DESCRIBE WORK BEING DONE: I.2 R- I��r�.,,* �! �f -„ ,- �„i. - SIZE OF IMPROVEMENT LENGTH WID H HEIGHT S FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl �Soffit ADDIT'IONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures and proposed project. ❑ Other � Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS l�Yes ❑No LOCATfON OF WINDOWS FOR WINDOWS - PROVIDE U-VALUE AND OR FOR NEW OPEN[NGS-DESCRIBE SIZE OF � I I MANUFACTURE STICKER ON WINDOW. OPENII3G CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL NLE� AKE 13A��li U1V VALUAI IUN, 1NCLUll1NG "1'HE CU5�1' UN' LABUK ANll MA"I'EHIALS: r, (USING THE 1997 U.B.0 FEE SCHEDULE) 'OTAL JOB VALUATION Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due OCCUPANCY TYPE $ c�'� ,a See Back Page for Fee Schedule $ 65% of Building Permit Fee $ .001 times the total job valuation $ .0005 x Permit Valuation Minimum $.50 $ $5.00 (State Licensed Residential Contractors) $ $2000 per SAC Unit (Plans to MWCC for determination) $ ft+6fr= ftx$22=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ . Make checks �avable to: Citv of Fridlev Attach THIS IS AN APPLICATTON FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT ��,�/ PRINT NAME % c4dc� �,1s ki DATE �— �' Q Q ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 �63) 572-3604 FAX: (763) 502-4977 REPRINTED ON 11/23/2009 : 6554 BROOKVIEW DR NE : 133024230035 : BROOKVIEW 2ND ADD : LOT 4 BLOCK 2 : BUILDING : RESIDENTIAL CONSTRUCTION TYPE : SIDING/WINDOWS VALUATION : $ 5,400.00 PERMIT NO.: 2009-01292 DATE ISSUED: 09/OU2009 NOTE: PER R703, 2000 INTERNATIONAL RESIDENTIAL CODE, REQUIRES THAT A WEATHER RESISTNE BARRIER BE PLACED OVER EXTERIOR SHEATHING TO PROTECT THE INTERIOR WALL COVERING. CALL FOR INSPECTION OF WRAP BEFORE COVERING. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. CONSTRUCTION IN THE CITY IS UNLAWFUL EXCEPT BETWEEN THE HOURS OF 7:00 AM AND 9:00 PM, MONDAY THROUGH FRIDAY AND BETWEEN THE HOURS OF 9:00 AM AND 9:00 PM ON SATURDAYS. NO WORK IS ALLOWED ON SUNDAYS OR ANY LEGAL HOLIDAY UNLESS AN ALTERNATE WORK HOUR PERMIT HAS FIRST BEEN ISSUED. PROVIDE HOUSE NUMBERS MIN. 3" IN HEIGHT PER CITY ORD 204.07 12 REPLACEMENT WINDOWS, SOFFIT AND FASCIA ON GARAGE. STATE LICENSED CONTRACTOR? 1 APPLICANT DONERIGHT BUILDING & REMODELING LLC 3731 200TH ST SOUTH HAVEN, MN 55382- (320) 260-0904 Minnesota State License #: 20628945 OWNER THIRD STAGE INVESTMENTS 6554 BROOKVIEW DR NE FRIDLEY, MN 55432- AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 180 days or if construction or work is suspended or abandoned for a period of 180 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date BUILDING PERMIT FEE FIRE SURCHARGE STATE SURCHARGE, BLDG VALUE LICENSE SURCHARGE TOTAL PAID WITH CC # 6034 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 125.25 5.40 2.70 5.00 13835 ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 �63) 572-3604 FAX: (763) 502-4977 REPRINTED ON 11/23/2009 : 6554 BROOKVIEW DR NE : 133024230035 : BROOKVIEW 2ND ADD : LOT 4 BLOCK 2 : ELECTRICAL : RESIDENTIAL : ELEC CIRCUITS PERMIT NO.: 2009-01833 DATE ISSUED: 1 U19/2009 NOTE: CALL ROBERT CLAUSON AT 651-777-7885 WEEKDAYS FROM 7-8:30 AM FOR REQUIRED INSPECTIONS. REHAB HOME ENTER ELECTRICAL FEE 100 APPLICANT DIRECT ELECTRIC INC 17262 94TH ST SE BECKER, MN 55308- (763) 263-8334 Minnesota State License #: CA05159 OWNER THIRD STAGE INVESTMENTS 6554 BROOKVIEW DR NE FRIDLEY, MN 55432- AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 180 days or if constructio� or work is suspended or abandoned for a period of 180 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date ELECTRICAL PERMIT FEE STATE SURCHARGE, ELEC FLAT TOTAL PAID WITH CHECK # 3921 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 100.00 0.50 100.50